accelerated art initiation for pwhiv who are out of care

Conditions: HIV Infections; ART; Noncompliance, Patient

Summary: the main purpose of the study is to evaluate the effectiveness, of the accelerate model of care to achieve hiv viral suppression at week 24. the study will also assess the acceptability, appropriateness, feasibility, and sustainability of the accelerate model of care. the accelerate model combines a standardized method for outreach, the use of telehealth for rapid access to an hiv care provider, a simplified pre-approved hiv regimen, a free 30-day medication starter supply, and re-linkage to medical care.

this is a multisite prospective hybrid (effectiveness-implementation) type 2 design, single-arm, mixed-methods study of a simplified accelerated art initiation protocol for people with hiv who are out of care. the investigators will assess the effectiveness of achieving hiv viral suppression defined as hiv rna \< 200 copies/ml at week 24 with b/f/taf (biktarvy) as a rapid start for pwh who are out of care. the investigators will also study the acceptability, feasibility, and sustainability of an innovative model of care that combines a standardized method for outreach, the use of telehealth for rapid access to an hiv care provider, a simplified pre-approved art regimen, a mailed free starter, and re-linkage to care as an implementation science study, the investigators will explore the methods and factors influencing the successful integration of evidence-based practices across diverse settings. this study will also ask the staff implementing the accelerate approach about its ease of use, feasibility, compliance, and possible obstacles to its application.

Eligibility criteria:
plwh inclusion criteria: participants must meet all the following inclusion criteria 1. 18 years or older at the time of obtaining the informed consent 2. speaks english 3. able to give consent which includes the ability to understand and comply with study requirements and instructions as judged by clinic or study staff 4. hiv-1 infection as documented by positive hiv test (positive laboratory hiv 1/2 antibody differentiation assay or detectable hiv -1 rna) 5. out of care, defined as not had a medical visit with an hiv care provider with prescribing privileges for ≥6 months and not receiving art for ≥1 month (by self-report) site staff inclusion criteria: participants must meet all the following inclusion criteria 1. 18 years or older at the time of obtaining the informed consent 2. hiv care providers, case managers, pharmacists, or administrators involved in administrative or clinical aspects of the intervention at participating sites 3. understand the long-term commitment to the study and be willing to participate 4. have adequate resources to complete assessments for the duration of the study exclusion criteria plwh exclusion criteria: participants who meet any of the following criteria are excluded 1. biktarvy (b/f/taf) contraindicated or not recommended 1. known history of chronic kidney disease (creatinine clearance \<30 ml/min) using cockcroft-gault formula and not on chronic dialysis 2. known history of allergy to b/f/taf components 3. known history of intermediate-high level resistance to b/f/taf components (score ≥30 on stanford hiv drug resistance algorithm) in the available medical record (not having a prior genotype or having m184v/i mutation is not an exclusion criterion) 4. concomitant use of contraindicated medications: using drug interaction database either lexicomp® drug interactions (category x avoid combination) or liverpool hiv interactions checker (category do not co-administer) or study drug label (uspi) as reference for list of contraindicated meds. 5. pregnant (by self-report) or planning to become pregnant while enrolled in the study 2. hiv-2 infection 3. plwh who are breastfeeding and are not on art or taking art without virologic suppression since breastfeeding will not be recommended. 4. active opportunistic infections that would require a delay of art as judged by the hiv care provider and based on current guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with hiv: such as cryptococcal and tuberculous meningitis, and cmv retinitis.16 5. not residing in the state of missouri at the time of the study or planning to relocate during the study period 6. incarcerated at the time of the study enrollment. site staff exclusion criteria: 1) moving practice location or job relocation within 1 year